Nursing Care Plan (NCP) for Leukemia

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Outline

Pathophysiology

Leukemia is cancer of the blood forming tissues and usually involves the white blood cells. The bone marrow produces abnormal white blood cells that do not function properly. The life cycle of the white blood cells is changed and the cells do not die when they should, thus accumulating and taking up space. They eventually crowd out the good cells which impairs the growth and function of healthy cells.  There are many types of leukemia. Some types can be cured while others cannot. Treatment is highly dependent upon the type of leukemia

Etiology

Scientists don’t fully know the exact etiology of leukemia , but believe that it may come from a combination of genetic and environmental factors. Genetics, radiation or chemical exposure, viruses (HIV), previous chemotherapy, and those with Down Syndrome appear to have a higher incidence of leukemia.

Desired Outcome

Minimize complications and resolve if possible. Maximize the normal blood cells and minimize the abnormal cells.

Leukemia Nursing Care Plan

Subjective Data:

  • Loss of appetite, weight loss
  • Tendency to bruise or bleed
  • Fatigue, weakness
  • Bone pain

Objective Data:

  • Frequent infections
  • Fever
  • Swollen lymph nodes
  • Enlarged liver / spleen
  • Petechiae
  • Recurrent nosebleeds
  • Prolonged clotting factors
  • Elevated WBC
  • Pallor

Nursing Interventions and Rationales

  • Initiate bleeding precautions

 

Clotting factors are impaired and patients are at a higher risk of bleeding and bruising

 

  • Assess and manage pain appropriately
    • Massage
    • Positioning
    • Cool/heat therapy
    • Aromatherapy
    • Guided imagery
    • Medications as necessary

 

Pain can be difficult to control and manage and medications may be scheduled with PRN measures for breakthrough pain. Make sure the intervention is appropriate for the patient and avoid extra stressors such as movement. Encourage patient to try non-pharmacological interventions and balance those with medication for more comprehensive pain control.

 

  • Monitor for signs / symptoms of infection or sepsis

 

Especially during treatment, patients are at higher risk of developing sepsis.  Monitor closing for signs and symptoms and notify MD as necessary.

 

  • Promote normothermia

 

Progressive hyperthermia may occur as the body’s response to disease and effects of treatment. Monitor temperature closely, especially during chemotherapy.

 

  • Anticipate needs

 

Time pain  and nausea medications at their peak according to therapy, chemo and meal times to increase their effectiveness

 

  • Monitor Intake & Output and signs/symptoms of dehydration
    • Skin turgor
    • Dry mucous membranes
    • Capillary refill

 

Dehydration and kidney compromise is a potential complication of disease and treatment. Encourage hydration and monitor closely.

 

  • Patient and family education
    • Symptoms and disease process
    • Infection prevention
    • Plan of care

 

Patients and family members must be knowledgeable of process and what to expect to help reduce anxiety and be prepared for complications as they arise.  Educate family members and caregivers of the importance to help reduce risk of infection for the patient by practicing good hand hygiene.

 

  • Avoid risk of infection from procedures:
    • Foley catheter insertion
    • Injections
    • Lines and tubes

 

Lack of sufficient white blood cells damages the immune system and patients are more prone to infections. Weight risk versus benefit.

 

  • Promote self care, independence and ADLs

 

Fatigue is a common symptom and can prevent the patient from participating in self care. Provide assistance with ADLs as needed and cluster care to reduce fatigue and promote rest. Prioritize activities to help conserve energy for self care.

Writing a Nursing Care Plan (NCP) for Leukemia

A Nursing Care Plan (NCP) for Leukemia starts when at patient admission and documents all activities and changes in the patient’s condition. The goal of an NCP is to create a treatment plan that is specific to the patient. They should be anchored in evidence-based practices and accurately record existing data and identify potential needs or risks.


References

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Transcript

Hey Guys, let’s take a look at the care plan for leukemia. In this lesson, we’ll briefly take a look at the pathophysiology and etiology of leukemia. We’ll also take a look at additional things like subjective and objective data, as well as nursing interventions and rationales. 

 

So leukemia is cancer of the blood forming tissues, and usually involves the white blood cells. The bone marrow produces abnormal white blood cells that do not function properly. The life cycle of the white blood cell is changed and the cells do not die when they should, thus they accumulate and take up space. So the non-functioning cells crowd out the good cells, which impairs the growth and function of the healthy cells. There are many types of leukemia, so some types can be cured while others cannot. Treatment is going to be highly dependent on the type of leukemia. Scientists don’t fully know the exact etiology of the disease. It’s believed that it may come from a combination of environmental and genetic factors, genetics, radiation, or chemical exposure, viruses like HIV, previous chemotherapy, and those with down syndrome appear to have a higher incidence of leukemia. 

 

The desired outcome is to minimize complications and resolve if possible, maximize the number of those normal blood cells and minimize the abnormal blood cells. Let’s take a look at the subjective and objective data that your patient with leukemia may present with. Remember,  subjective data are going to be things that are based on your patient’s opinions or feelings. These things may include loss of appetite, weight loss, the tendency to bruise or bleed, fatigue, weakness, and bone pain. 

 

Objective data may include frequent infections, fever, swollen lymph nodes, enlarged liver, or spleen, petechiae, recurrent nosebleeds, prolonged clotting factors, elevated white blood cells, and pallor. 

 

Let’s take a look at the nursing interventions necessary when caring for a patient with leukemia.  It is extremely important to initiate bleeding precautions as clotting factors in leukemia patients are impaired and patients are at a higher risk of bleeding and bruising. So, assess any pain in your patient’s. Pain can be difficult to control and manage and pain medications may only be scheduled as PRN for breakthrough pain. So, other interventions like massage, repositioning, or positioning, cool and heat therapy, aroma therapy, guided imagery may be helpful in addition to medication for more comprehensive pain control. Make sure the intervention is appropriate for the patient and also avoid extra stressors. Especially during treatment, patients are at a higher risk for developing sepsis, so monitor closely for signs and symptoms of infection and notify the provider. Also progressive hyperthermia may occur as the body’s response to the disease and the effects of treatment, so monitor your patient’s temperature closely, especially during chemo.  Try your best to anticipate the needs of your patient, meaning time pain and nausea medications at their peak according to therapy, chemo, and meal times to increase effectiveness. 

 

Dehydration and kidney compromise is a potential complication of disease and treatment, so monitor for signs of dehydration, hydration, including skin turgor, dry mucous membranes, and capillary refill, and encourage hydration in your patient and monitor closely.  Patients and family members must be knowledgeable in the disease process as well as what to expect to help reduce anxiety, and also to be prepared for complications as they arise. 

 

Educate the patient, family and caregivers of the importance of helping reduce the risk of infection for the patient by practicing good hand hygiene. Certain procedures like catheter insertion, injections, lines, and tubes, things that we as providers may take for granted as simple or low risk procedures, need to be thought of as risk versus benefit for leukemia patients. These patients have a lack of sufficient white blood cells that damages the immune system and makes the patient more prone to infections even with the most basic of procedures. So, with leukemia patients, fatigue is a super common symptom which may make it difficult for the patient to participate in self care. Provide assistance with ADL’s as needed and cluster care to reduce fatigue and promote rest. Prioritize activities to help conserve their energy for self care. 

 

Here is a look at the completed care plan for leukemia. Okay guys, that’s it for this lesson. We love you guys. Now, go out and be your best self today and as always, happy nursing!

 

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